In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Past President Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM, elaborates on the session presented during the 2026 Critical Care Congress, Critical Care Under Pressure: Sustaining the Workforce and Infrastructure Amid Rising Demands.

Joined by host Marilyn Bulloch, PharmD, BCPS, FCCM, Dr. Pascual examines the complex forces reshaping critical care, from shrinking ICU capacity and hospital closures to persistent workforce shortages and shifting training pipelines. He highlights concerning trends such as reduced entry into certain critical care pathways, particularly anesthesiology. At the same time, he points to encouraging growth in other pathways, with increasing participation from clinicians in emergency medicine, neurology, and surgery.

The conversation underscores disparities in access to care, particularly for rural and community hospitals. Dr. Pascual explores the tension between the regionalization of specialized care and the need to maintain equitable access across health systems, emphasizing the importance of thoughtful resource distribution and collaboration across institutions. Beyond workforce numbers, the evolution of leadership in critical care is also impactful, including the migration of experienced clinicians into administrative roles and the potential need for cyclical leadership models that maintain clinical engagement.

Meeting these challenges requires innovation and cooperation. Dr. Pascual highlights advancements in education, particularly the expansion of simulation-based training, as critical tools for maintaining competency and improving team performance.

Resources referenced in this episode: 

• 2026 Congress Digital

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Samantha Gambles Farr, MSN, NP-C, CCRN, RNFA, speaks with Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, Making Sepsis the Next Success Story in Global Health. The panel also discusses how access and equity play a part in how sepsis is treated.

From a global perspective, Dr. Kissoon emphasizes that the most important thing is advocacy and prevention from a governmental level by creating national action plans, making sure the healthcare system is resilient, and utilizing technology and innovation to create better ways of providing care; and from a societal level by educating patients and families about nutrition, hygiene, vaccinations, and seeking care early.

Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, is a professor in the Department of Pediatrics (Pediatrics and Surgery, Emergency Medicine) at the University of British Columbia in Vancouver, British Columbia, Canada. He is the past president of the World Federation of Pediatric Critical and Intensive Care Societies and currently serves as president of the Global Sepsis Alliance. He is cochair of the pediatric Surviving Sepsis Campaign, vice president of the Canadian Sepsis Foundation, and chair of World Sepsis Day and the International Pediatric Sepsis Initiative. He also serves on the Sepsis Alliance USA and the African Sepsis Alliance advisory boards and is also a founding member of the Caribbean Sepsis Alliance.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Michael R. Pinsky, MD, FAPS, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, The Effective Management of Shock: Moving From Physiology to Guidelines to Precision Medicine and Ultimately Personalized Medicine. The panel also discusses how to titrate care for individual patients.

Protocols and guidelines are the foundation for patient care and are instrumental for having all healthcare professionals on the same baseline when treating patients. Precision medicine involves individualizing care for a specific patient, and Dr. Pinsky emphasizes that guidelines should never supersede an understanding of pathophysiology at the bedside, including observing your patient and paying attention to how individual patients respond to specific treatments. Monitoring the individualized response is required for the best care.

Michael R. Pinsky, MD, FAPS, MCCM, is a professor of critical care medicine, bioengineering, and anesthesiology at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA. He is also Docteur Honoris Casusa at the Université René Descartes Paris V School of Medicine in Paris, France. In 2012, he became one of the first 20 critical care physicians to receive a Master of Critical Care Medicine (MCCM) from SCCM. He is currently an emeritus (honorary) at UPMC. At the University of Pittsburgh, he is vice-chair emeritus for the Department of Critical Care Medicine and a faculty member at the Center for Critical Care Nephrology and the Center for Military Medicine Research.

Resources referenced in this podcast:

• The Effective Management of Shock: Moving From Physiology to Guidelines to Personalized Medicine

The guidelines, “Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome,” were published in the March issue of Critical Care Medicine.

Drs. Sarwal and Erstad discuss how the evidence in two key trials, ACURASYS and PETAL-ROSE, has helped shape the recommendations provided in the SCCM guidelines. Despite how influential these trials were in shaping the recommendations, only conditional recommendations were made due to low or very low quality of evidence. The lack of evidence proved to be a driving factor in including a call to action in the guidelines. Future research priorities largely revolve around precision medicine and finding more patient-specific interventions to improve patient outcomes.

Aarti Sarwal, MD, FAAN, FNCS, RPNI, FCCM, is a professor of neurology and the division chair of neurocritical care at Virginia Commonwealth University (VCU) School of Medicine in Richmond, Virginia, USA. She is also an associate editor of Critical Care Medicine, secretary of the American Society of Neuroimaging, and director of VCU-Wake Forest neuro-ultrasound courses. Brian L. Erstad, PharmD, FCCP, FASHP, MCCM, is a tenured professor and interim dean at the University of Arizona R. Ken Coit College of Pharmacy in Tucson, Arizona, USA. He is also a center investigator for the Center for Health Outcomes, a member of the BIO5 Institute and Comprehensive Center for Pain & Addiction and Pharmacoeconomics Research Center, and a codirector for the Arizona Clinical and Translational Research Graduate Certificate Program.

Resources referenced in this podcast:

• Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome

• Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome

• Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, and Lauren E. Ferrante, MD, MHS, to discusses new guidelines on caring for older adults in the ICU and the difficulties in finding research that focuses on those patients.

The guidelines, “Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU,” will be published in an upcoming issue of Critical Care Medicine.

The panel details the process and methodology behind the guidelines, the dearth of studies focusing on older patients in the ICU, and the difficulty of finding studies that enroll older adults who are on multiple medications. The guidelines offer two conditional recommendations and offer priorities for aging-friendly research topics to help provide stronger guidance in the future.

Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, is an associate professor, intensivist, and researcher based at McMaster University in Hamilton, Ontario, Canada, who focuses on intravenous fluid use in sepsis, the role of corticosteroids in acute hypoxemic respiratory failure, and clinical practice guideline methodology. Lauren E. Ferrante, MD, MHS, is an associate professor of medicine in the section of pulmonary, critical care, and sleep medicine at the Yale School of Medicine; director of the operations core of the Yale Claude D. Pepper Older Americans Independence Center; and an attending physician in the medical intensive care unit at Yale-New Haven Hospital in New Haven, Connecticut, USA.

Resources referenced in this podcast:

• Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU

• Compassionate and Evidence-Based Care (session from the 2026 Critical Care Congress)

• Congress Digital

• Geriatric Knowledge Education Group

• Thought Leader: Why the 4Ms Approach to Critical Care Improves Quality (session from the 2025 Critical Care Congress)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with pediatric SSC guideline cochairs Scott L. Weiss, MD, MSCE, FCCM, and Pierre Tissieres, MD, DSc, about the latest guideline recommendations for the care of children with sepsis and septic shock. The updated guidelines emphasize the early identification of sepsis, an evolution to a more targeted way of treatment, and a more practical approach to guideline implementation. Other aspects of the previous guidelines, such as lactate measurements, continuous reassessment, and the role of point-of-care monitoring, were reinforced in the 2026 guidelines.

The guidelines, “Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026,” were released in the April issue of Pediatric Critical Care Medicine.

Key updates and new areas of emphasis include:  

• A more nuanced approach to sepsis screening and early recognition 

• New guidance on supplemental oxygen, including limiting hyperoxia and using more conservative oxygenation targets in children with septic shock 

• New patient, intervention, comparison, outcome questions related to immune dysregulation, highlighting an important area for future research 

• New attention to post-sepsis morbidity 

• Greater emphasis on long-term follow-up and risk assessment for children who survive sepsis

Scott L. Weiss, MD, MSCE, FCCM, is division chief of critical care and vice-chair of research at Nemours Children’s Hospital (DuPont)-Delaware and professor of pediatrics and pathology and genomic medicine at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Pierre Tissieres, MD, DSc, is a professor of pediatrics and head of Pediatric ICU and Neonatal Medicine at Paris South University Hospitals in Paris, France.

This podcast is sponsored by Vantive. 

At Vantive, our mission to extend lives and expand possibilities starts with a commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.

Resources referenced in this podcast: 

• Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026 

• Executive Summary of Society of Critical Care Medicine 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life 

• International Consensus Criteria for Pediatric Sepsis and Septic Shock

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Kyle B. Enfield, MD, is joined by guideline cochairs Massimo Antonelli, MD, and Hallie C. Prescott, MD, MSc, FCCM, for a practical discussion on the biggest updates in the care of adults with sepsis and septic shock, from appropriate care during transport to the hospital to balancing timely antibiotics with antimicrobial stewardship. The panel also discusses hemodynamic resuscitation, vasopressor selection, global implementation, and the growing recognition that sepsis care does not end at hospital discharge.

The guidelines, “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026,” were released in the April issue of Critical Care Medicine.

The episode highlights:  

• How the panel graded the evidence 

• New sepsis terminology to address variabilities in how different professions, environments, or cultures refer to specific features of sepsis 

• How the guidelines are shaped to support clinicians practicing in a wide range of care settings, including resource-limited settings

Dr. Antonelli is a professor of anesthesiology and intensive care medicine at Università Cattolica del Sacro Cuore in Rome, Italy, and director of the general intensive care unit at Policlinico A. Gemelli University Hospital. Dr. Prescott is a professor of pulmonary and critical care medicine at the University of Michigan, Ann Arbor, Michigan, USA, and a staff physician at the Ann Arbor Veterans Affairs Healthcare System.

This podcast is sponsored by Vantive.

At Vantive, our mission to extend lives and expand possibilities starts with the commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.

Resources referenced in this podcast: 

• Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 

• Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 

• Restriction of Intravenous Fluid in ICU Patients with Septic Shock 

• Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, is joined by John A. Kellum, MD, FCCM, to discuss high endotoxin activity as a possible endotype for septic shock. Dr. Kellum’s article, “Organ Failure, Endotoxin Activity, and Mortality in Septic Shock,” was published in the September 2025 compendium of Critical Care Explorations. Dr. Kellum is a professor and director of the Center for Critical Care Nephrology, as well as vice chair for the Department of Critical Care Medicine, at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA.

The study used a novel biomarker called the endotoxin activity assay (EAA) to detect endotoxin in the blood. While the EAA is not good at identifying patients who are at risk for sepsis, Dr. Kellum said that, when combined with organ failure, it identifies patients at high risk for endotoxic septic shock. In the study, these patients had a mortality rate of 60%.

Neither the EAA nor the anti-endotoxin therapy is readily available. And, although endotoxic septic shock is rare, occurring in only a quarter of patients with septic shock, Dr. Kellum hopes that, through precision medicine, segmenting this population into treatable subgroups may allow better diagnostics and opportunities to develop or repurpose therapies in the future. This episode is sponsored by Prenosis.

Resources referenced in this episode:

• Organ Failure, Endotoxin Activity, and Mortality in Septic Shock (Molinari  L, et al. Crit Care Explor. 2025;7:e1308)

• Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis (Seymour CW, et al. JAMA. 2019;321:2003-2017)

• Safety and Efficacy of Polymyxin B Hemoperfusion (PMX) for Endotoxemic Septic Shock in a Randomized, Open-Label Study (TIGRIS) (ClinicalTrials.gov. ID NCT03901807. Last update posted January 9, 2026)

Differing ventilatory strategies and the heterogeneous phenotypes of bronchiolitis motivated Dr. Varela’s team to investigate airway closure, which was detected in seven of the 12 patients included in the study. Airway opening pressure frequently exceeded the set positive end-expiratory pressure (PEEP) levels—highlighting a potential gap in traditional ventilator management. Dr. Varela explains that respiratory mechanics, particularly driving pressure and respiratory system compliance, can be misinterpreted when airway opening pressure is not considered.

Study limitations included bacterial coinfection in nearly half the patients and the constraints of a single-center design, but Dr. Varela said that these factors did not appear to alter the physiologic observations.

Although more research is needed before making clinical recommendations, the study established a foundational understanding of airway closure in patients with bronchiolitis and underscores the need for future work on personalized ventilation strategies, PEEP titration, and the potential heterogeneity of airway behavior in this population.

Resources referenced in this episode:

• Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure (Varela J, et al. Pediatr Crit Care Med. 2025;26:e1096-e1104)

• Airway Closure in Acute Respiratory Distress Syndrome: An Underestimated and Misinterpreted Phenomenon (Chen L, et al. Am J Respir Crit Care Med. 2018;197:132-136)

Dr. Yehya discusses how the project emerged from a long-standing question in pediatric critical care research: Are the outcomes we measure in clinical trials aligned with the priorities and lived experiences of families? Because mortality is low in pediatrics, composite short-term outcomes such as ventilator-free days, ICU-free days, and hospital-free days are commonly used. However, little is known about whether these metrics are truly patient- and family-centered.

Using survey data from parents and PICU clinicians, the study found strong agreement between parents and clinicians on the importance of minimizing duration of invasive mechanical ventilation. But parents and clinicians diverged on other short-term outcomes. Families ranked oxygen duration as more important than ICU or hospital length of stay, reflecting concerns about ongoing medical needs, missed work, and the possibility of going home on oxygen. Clinicians prioritized ICU and hospital days over oxygen use. Substantial variation was also found within both groups.

Dr. Yehya highlights the value of feedback from patient and family advisory councils in designing this type of research, explaining that such feedback informed the study’s instrument design and family approach. He calls for deeper investigation into post-discharge recovery, functional outcomes, and long-term developmental trajectories—areas families consistently identify as their greatest concerns.

Resources referenced in this episode:

• Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children (Shannon MM, et al. Pediatr Crit Care Med. 2025;26:e1149-e1153)

Dr. Hamzaoui shares insights on current scientific understanding of microcirculation and shock, including research on tools to monitor microcirculation, such as handheld video microscopy. The discussion highlights the utility of capillary refill time as a simple, noninvasive tool for guiding resuscitation. Dr. Hamzaoui advocates for early and repeated echocardiographic assessment in shock management, including during de-resuscitation. She also discusses her 2023 article in Clinical Medicine, which proposed titrating norepinephrine to individualized targets.

This episode offers a compelling look at how emerging tools and research can refine shock management and promote precision care in critical illness.

This podcast is sponsored by Fresenius Kabi.

Resources referenced in this episode: 

• Effects of a Resuscitation Strategy Targeting Peripheral Perfusion Status versus Serum Lactate Levels Among Patients with Septic Shock. A Bayesian Reanalysis of the ANDROMEDA-SHOCK Trial (Zampieri FG, et al. Am J Respir Crit Care Med. 2020;201:423-429)

• The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock (Hamzaoui O, et al. J Clin Med. 2023;12:4589)

• Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143)

Dr. Rai explains how positive anecdotal experiences of animal therapy in the ICU inspired his team to conduct this study. Guided by infection control protocols, they implemented a program allowing accredited therapy dogs to visit patients and families for 15- to 20-minute sessions. More than 60% of patients and more than 90% of family members had a clinically meaningful reduction in anxiety scores, and patients reported decreased pain. No adverse events were observed, demonstrating the feasibility and safety of this approach.

Dr. Rai addresses the study’s limitations, such as the impracticality of conducting a randomized trial, and highlights the need for research into staff well-being, which appeared to benefit from therapy dog visits. He also underscores the importance of a safety program, including infection control precautions.

This episode offers practical insights for implementing animal therapy programs in the ICU and invites listeners to consider new approaches to improving mental health and well-being for patients, families, and staff.

Resources referenced in this episode: 

• Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study (Cook K, et al. Crit Care Explor. 2025;7:e1258).

The SANDWICH trial, conducted in the United Kingdom, evaluated a nurse-led intervention of sedation scoring, goal-based sedation weaning, and protocolized extubation readiness testing. While the original trial demonstrated only a modest reduction in ventilation duration, Dr. Mitting’s subgroup analysis of infants with bronchiolitis found a reduction of median time to successful extubation by approximately 16 to 17 hours.

Dr. Mitting highlights the importance of these findings during the winter season when bronchiolitis drives up PICU occupancy and strain. The critical trade-off between minimizing ventilator days and avoiding extubation failure is discussed, as well as implementation challenges after the COVID-19 pandemic, the importance of protocolized care under resource strain, and future directions for predictive models and personalized strategies to optimize extubation timing.

Listeners will gain practical insights into evidence-based approaches for improving outcomes in infants with bronchiolitis and the broader implications for PICU workflow and patient safety.

Resources referenced in this episode:

• Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial (Mitting RB, et al. Pediatr Crit Care Med. 2025;26:e423-e431).

• Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial (Blackwood B, et al. JAMA. 2021;326:401-410).

Dr. Mohiuddin discusses the need to address the global shortage of donated organs and the use of genetically modified pig organs as a viable solution. He explains the science behind xenotransplantation, including the use of CRISPR-Cas9 gene editing technology to delete immunogenic pig genes and insert human-compatible genes. The conversation explores the unique immunologic challenges of xenotransplantation, particularly antibody-mediated rejection and the need for tailored immunosuppression protocols.

Ethical considerations include religious perspectives and public opinion. Dr. Mohiuddin emphasizes the importance of continued research funding and collaboration with industry partners to advance clinical trials and refine genetic modifications.

Listeners will gain insight into how decades of research are transforming xenotransplantation and its potential to extend life and reshape the future of organ transplantation.

Dr. Fulmer shares her journey from bedside critical care nurse to national leader in geriatric health, emphasizing the need to adapt healthcare systems to meet the needs of an aging population. She discusses the development of the Age-Friendly Health Systems initiative, a collaboration among the John A. Hartford Foundation, Institute for Healthcare Improvement, American Hospital Association, and Catholic Health Association. Now implemented in nearly 5000 facilities, the initiative is supported by evidence from models such as the Acute Care of the Elderly (ACE) units, Hospital Outcomes Program for Elders (HOPE) initiative, and Nurses Improving Care for Healthsystem Elders (NICHE) program.

The episode highlights the January 2025 adoption of a Centers for Medicare and Medicaid Services measure that incorporates the 4Ms into inpatient care standards. Dr. Fulmer explains how hospitals of all sizes can implement age-friendly practices using existing resources and how multiprofessional collaboration is key to success. She also discusses findings from a national survey from Age Wave and the John A. Hartford Foundation, which revealed that only 19% of older adults feel their clinicians consistently address all 4Ms.

Listeners will gain insight into how the 4Ms framework improves outcomes and promotes functional recovery in older adults. Whether you're a clinician, educator, or healthcare leader, this episode offers practical strategies and a compelling call to action to join the age-friendly health systems movement.

Drawing from his own nontraditional path into nursing and advanced practice, Dr. Boling shares how self-directed learning—through podcasts, blogs, and social media—can supplement formal education and foster professional growth. He emphasizes the importance of building a personalized curriculum that balances foundational knowledge with emerging trends and encourages learners to focus not only on hot topics but also on the essential, everyday skills that drive patient outcomes. The conversation highlights strategies for identifying credible educational resources and maintaining work-life balance while pursuing lifelong learning.

Listeners will gain insights into how experienced clinicians can support novice colleagues through informal mentorship and bedside teaching and how honesty about knowledge gaps can lead to deeper learning. Whether you're a new graduate, a transitioning clinician, or a seasoned clinician looking to mentor others, this episode offers practical guidance for education, growth, and leadership in critical care.

Dr. Wang shares his journey from medical school in China to building a neurocritical care service line in the United States, highlighting how mentorship shaped his path at every stage. He reflects on the challenges of entering a healthcare system in a new country and emphasizes the benefits of connecting mentors and mentees who share similar backgrounds and experiences. Dr. Wang’s ICCP mentor provided guidance during the launch of his ICU leadership role, offering insights into service line development and support during challenging situations.

The ICCP program, developed from a proposal by José L. Díaz-Gómez, MD, MAS, FASE, FCCM, launched its first six-month pilot in January 2024. The program focuses on five key domains: psychological and emotional support, self-efficacy, career development, scholarly support, and role modeling. A second pilot, currently under way, extends the mentorship to a full year.

This episode will inspire listeners to seek mentorship and community to advance their careers and grow their confidence. Mentorship is not just about guidance—it’s about building relationships that empower individuals to lead, innovate, and give back.

The guests explore the nuances of evaluating job offers and negotiating compensation, as well as prioritizing onboarding, mentorship, and job fit. Dr. Hakimi shares insights from his leadership roles in academic neuro-ICUs and his longstanding advocacy for APPs, while Mr. Appino offers a strategic perspective on contract structures, compensation models, and negotiation tactics.

The discussion highlights the variability in contract practices across academic and private institutions, the importance of defining full-time employment expectations, and the role of offer letters versus formal contracts. Listeners will learn how to approach salary discussions with confidence, including when to negotiate, which data to reference (e.g., Medical Group Management Association and American Medical Group Association benchmarks), and how to assess a job offer beyond salary.

This episode is valuable for APPs at any career stage seeking fair compensation and sustainable career growth. It emphasizes that successful negotiations are not just about salary—they are also about clarity, support, and long-term professional satisfaction.

Their conversation explores the evolving challenges of pediatric ventilator liberation, such as balancing extubation readiness with risks related to prolonged invasive mechanical ventilation and noninvasive respiratory support. Topics include the role of spontaneous breathing trials, pressure support strategies, sedation practices, and the impact of noninvasive modalities such as high-flow nasal cannula and bilevel positive airway pressure. They address the importance of individualized care, especially for high-risk patients such as children with neuromuscular disorders.

Dr. Loberger explains the quality improvement efforts under way that focus on implementing current clinical practice guidelines, standardizing practice, and aligning goals. Listeners will gain a deep understanding of the nuanced decision-making involved in ventilator liberation and collaborative efforts to improve outcomes for critically ill children.

Resources referenced in this episode:

• Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence (Loberger JM, et al. Respir Care. 2024;69:869-880)

• Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document (Abu-Sultaneh S, et al. Am J Respir Crit Care Med. 2023;207:17-28)

Dr. Alexander is a clinical associate professor in the Department of Pharmacy Education and Practice at University of Florida. Dr. Sakhuja is the director of artificial intelligence and informatics at the Institute for Critical Care Medicine and director of clinical informatics research in the Division of Data-Driven and Digital Medicine.

The discussion highlights how critical care educators and clinicians benefit from learning how to use AI and understanding its benefits and limitations. Incorporating AI into critical care education teaches students how to use AI responsibly in school and later in clinical practice. Clinicians should understand the utility of different AI models for patient care and be well versed in the ethical and legal treatment of patient data.

Drs. Alexander and Sakhuja provide examples of practical uses for AI in critical care. AI can help students test their knowledge with interactive case simulations paired with discussion with instructors and peers. AI can analyze vast amounts of patient data, supporting clinical decision-making.

The guests encourage clinicians and educators in critical care to engage with AI and contribute to its responsible use. Listeners will gain valuable insights into the uses of AI.

The study compared liberal and restrictive strategies for patients with traumatic brain injury (TBI). They found that a liberal transfusion strategy results in better neurologic outcomes than a restrictive strategy. Drs. Bulloch and Bannach discuss the importance of optimizing transfusion thresholds, the risks and benefits of blood transfusion for critically ill patients, and the limited supply of donated blood.

The conversation also covers study methodology. Dr. Bannach explains the choice of main end point for the study, the process of selecting articles to include, and the rigorous peer review process.

Listeners will find guidance for optimizing blood transfusion in patients with TBI, as well as key insights into review methodology. More discussion of this article can be found in the April 2025 Critical Content video.

Resources referenced in this episode:

• Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (Larcipretti ALL, et al. Crit Care Med. 2025;53:e963-e972).

Drs. Enfield and Russotto explore the decision of which induction drugs to use for patients undergoing tracheal intubation. They discuss research challenges such as the ethics of which drugs can be tested on patients and the emergent nature of many tracheal intubations.

Dr. Russotto discusses the advantages and disadvantages of ketamine as an induction agent and describes current clinical thinking on etomidate and propofol. His study made no definitive conclusions but found evidence that ketamine may have a safer profile and etomidate and propofol may be associated with negative effects.

Dr. Russotto emphasizes the need to individualize patient treatment and shares examples of induction agent combinations. He encourages clinicians to consider hemodynamic optimization along with the use of intubation agents. Listeners will gain insights to inform patient care.

Resources referenced in this episode:

• Induction Agents for Tracheal Intubation in Critically Ill Patients (Kotani Y, et al. Crit Care Med. 2025;53:e173-e181).

The conversation offers key insights into the prevalence and long-term effects of post-intensive care syndrome (PICS). Dr. Tilburgs’ study surveyed intensive care unit (ICU) patients on their quality of life three months, twelve months, and two years after ICU discharge. The survey included physical, cognitive, and mental health domains. The findings show a significant link between PICS and diminished long-term quality of life.

Drs. Bulloch and Tilburgs discuss how these results highlight the need for PICS prevention across all three domains. They review potential strategies, such as diaries to help patients better understand their ICU experience. Dr. Tilburgs also highlights the benefits of his institution’s discussion group for ICU survivors.

Listeners will gain key insights on the long-term effects of PICS, actionable ideas for improving ICU patient care, and ideas for future research.

Resources referenced in this episode: 

• Associations Between Physical, Cognitive, and Mental Health Domains of Post-Intensive Care Syndrome and Quality of Life: A Longitudinal Multicenter Cohort Study (Tilburgs B, et al. Crit Care Med. 2025 Jan;53:e74-e86).

APP professional advancement programs aim to improve retention and engagement. Mr. Newman and Ms. Howard highlight additional benefits as well. They explain how the pilot professional advancement tracks at their institutions address specific needs of APPs.

Mr. Newman’s program addresses the challenge of recognizing and supporting the nonclinical contributions of predominantly clinical faculty such as APPs. Ms. Howard’s program recognizes APPs’ careers beginning at an early stage and incorporates salary advancement into the program.

The guests discuss the practical challenges of implementing a professional advancement model, including finding financial resources, obtaining institutional buy-in, and making the recognition relevant and meaningful to APPs’ work.

Both guests emphasize that professional advancement programs should motivate and engage APPs over the course of their careers and encourage more appreciation for their work. The conversation will motivate listeners to explore similar career development programs at their own institutions.

The study found racial equity in organ procurement organization (OPO) family approach among patients who were medically eligible for organ donation. Dr. Rodrigue and Mr. Hasz explain that previous studies showing racial disparity in family approach were based on 25- to 30-year-old data. The changes in organ donation systems since then were what motivated Dr. Rodrigue and Mr. Hasz to conduct new research.

Their findings highlight the positive impact of standardized OPO practices on equitable access to organ donation opportunities. Dr. Rodrigue and Mr. Hasz emphasize the importance of timely referral, family-centered communication, and coordination between hospital teams and OPOs in facilitating donation conversations during emotionally charged moments. These practices complement advances in technology and expanded donor eligibility criteria to make more donations possible. Integrating organ donation information into driver education programs and expanding registration opportunities to settings such as voter registration can also help increase awareness and informed consent, especially among young people.

Resources referenced in this episode: 

• Racial Equity in Family Approach for Patients Medically Suitable for Deceased Organ Donation (Rodrigue JR, et al. Crit Care Med. 2024;52:1877-1884).

Dr. Sachdev explains the development and implementation at his institution of a protocol for transpulmonary pressure (TPP) monitoring in pediatric patients with severe acute respiratory distress syndrome. His team compared outcomes of patients receiving TPP-guided ventilation with those receiving conventional mechanical ventilation. Study findings suggested that TPP monitoring enabled the use of higher positive end-expiratory pressure with greater clinician confidence, resulting in improved oxygenation.

Study limitations included small sample size and challenges of equipment availability, cost, and obtaining parental consent. The study was conducted in part during the COVID-19 pandemic, which further constrained resources and study participation.

The discussion concludes with Dr. Sachdev’s insights into practical challenges of TPP monitoring, including inserting delicate esophageal catheters in infants and young children and the necessity of correct catheter position for accurate readings.

Resources referenced in this episode:

• Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018–2021 (Sachdev A, et al. Pediatr Crit Care Med. 2025;26:e354-e363).

A key finding of the study was that VL probably improves first-pass success rates and reduces the risk of esophageal intubation and dental injury. These benefits extend across the spectrum of operator experience, especially among novice operators but also among seasoned operators.  

Drs. McDougall and Forestell discuss findings that surprised them, such as seeing equal benefit for standard VL and hyperangulated VL devices. Additionally, no clear benefits were found for patients who were intubated emergently with VL as compared to those who underwent elective intubation.

The discussion covers what could be next for resuscitation and airway research in critically ill patients. There may be more to learn about scenarios involving difficult airways, soiled airways, and emergent versus elective intubation. More research on device characteristics could also provide important insights.

To wrap up, the guests underscore the importance of maintaining both VL and DL proficiency since DL can be a more appropriate choice for some patients.

Resources referenced in this episode:

• Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials (McDougall GG, et al. Crit Care Med. 2024;52:1674-1685).

The conversation highlights growing concerns around burnout and attrition among ICU pharmacists, underscoring how their involvement improves clinical and economic outcomes—ranging from medication safety and reduced ventilator days to optimized transitions of care.

Drawing on American College of Clinical Pharmacy (ACCP) publications and American Society of Health-System Pharmacists (ASHP) guidance, Dr. Forehand outlines strategies for building retention plans that prioritize recognition, advancement opportunities, career mentorship, and structural supports such as protected administrative time. She emphasizes how institutional practices such as improved scheduling, remote work models, and role-specific stipends can prevent burnout while reinforcing team trust and efficiency.

Resources referenced in this episode:

• SCCM’s Leadership, Empowerment, and Development (LEAD) Program, which supports professional development

• Rewards, Recognition, and Advancement for Clinical Pharmacists (Bondi DS, et al. J Am Coll Clin Pharm. 2023;6:427-439)

Drawing on their personal experiences, the guests reflect on how early involvement through residency, fellowship, and the Fundamental Critical Care Support (FCCS) course ignited long-term involvement in the Society.

Drs. Wessman and Wang outline actionable strategies for new and seasoned members alike. They emphasize the value of committee and section participation, trainee liaison roles, and the mentorship programs, particularly the initiative tailored for international medical graduates. The conversation sheds light on the application process and professional significance of becoming a Fellow of the American College of Critical Care Medicine (FCCM).

Whether you're navigating your first SCCM Congress or considering applying for FCCM designation, this episode is a comprehensive guide to supersizing your SCCM membership—turning involvement into influence and professional growth into sustained impact.

Resources referenced in this episode:

• SCCM’s LearnICU platform

•  Choosing Wisely for Critical Care: The Next Five (Zimmerman JJ, et al. Crit Care Med. 2021;49:472-481)

• The Definition of the Intensivist in the Era of Global Healthcare (Wu D, et al. Crit Care Med. 2025;53:e548-e554).

In this SCCM podcast, Dr. Hamill reflects on his decade-long journey with FCCS, beginning with local implementation at his former institution to eventually leading national and international Fundamentals efforts. He shares powerful stories from training initiatives in Rwanda, Palestine, and war-time Ukraine—highlighting the program’s global reach and ability to empower frontline clinicians.

Central to the discussion is Dr. Hamill’s published study, “Impact of Standardized Multidisciplinary Critical Care Training on Confidence with Critical Illness and Attitudes Towards Interprofessional Education and Multidisciplinary Care” (Hamill ME, et al. J Intensive Care Med. 2024;39:320-327). The study analyzed survey data from 328 multidisciplinary learners and demonstrated significant increases in participants’ self-assessed confidence across key critical care domains—including sepsis, respiratory failure, shock, and neurologic illness—after completing FCCS. The findings support what many instructors have long observed anecdotally: FCCS builds competence, fosters interprofessional collaboration, and enhances learners’ readiness to respond to critically ill patients.

Dr. Hamill also explains the study’s methodology, including retrospective precourse analysis and a three-month follow-up, and shares insights about future research plans involving simulation-based evaluation to assess knowledge retention and behavior change.

Whether you are considering hosting a Fundamentals course, becoming an instructor, or expanding your training programs, this podcast episode offers compelling evidence of FCCS’s lasting value in skills acquisition and elevating the culture of care.

Dr. Sarwal shares her perspective on the unique challenges of managing neurocritically ill patients, particularly when impairment presents challenges in administering a neurologic examination. She emphasizes that “the brain is the barometer of critical illness,” urging clinicians to prioritize daily neurologic evaluations and integrate neuromonitoring even in non-neurologic ICU populations. Listeners will gain an overview of tools such as continuous EEG, transcranial Doppler, emboli monitoring, and multimodal neuromonitoring platforms, including the role of neuro-ultrasound in expanding point-of-care capabilities.

This episode also highlights the need for multidisciplinary collaboration and a shared decision-making model that extends across the continuum of care—from early ICU admission to post-discharge recovery.

Listeners will appreciate Dr. Sarwal’s reflections on neuroprognostication and the ethical dimensions of care withdrawal, particularly the danger of therapeutic nihilism in patients whose outcomes are uncertain. Referencing a 2023 review she coauthored (Crit Care Med. 2023;51:525-542), Dr. Sarwal outlines a practical framework for neuromonitoring that integrates structural, electrical, vascular, and metabolic insights.

This conversation provides a timely and inclusive look at the future of neurocritical care—where technology, teamwork, and training converge to support better patient outcomes.

Instead of treating ARDS as a single, homogenous condition, researchers are increasingly identifying biologically distinct subgroups—especially hyper- and hypoinflammatory phenotypes—that may respond differently to therapies. These insights are fueling a new generation of trials that aim to prospectively apply this knowledge to treatment strategies.

Central to this evolution is the Precision medicine Adaptive platform Network Trial in Hypoaemic acutE respiratory failure (PANTHER), of which Dr. McAuley is a team member. PANTHER is a Bayesian adaptive platform randomized clinical trial studying novel interventions to improve outcomes for patients with acute hypoxemic respiratory failure. Designed to be adaptive and biomarker informed, PANTHER will test therapies such as simvastatin and baricitinib, based on real-time phenotyping of patients with ARDS.

Throughout the episode, Dr. McAuley reflects on how advances in machine learning and biomarker identification are making precision treatment more feasible. He discusses the importance of maintaining evidence-based supportive care, such as lung-protective ventilation and prone positioning, while integrating new targeted therapies. Discover the latest investigations into potential therapeutic agents—including mesenchymal stromal cells, statins, and extracorporeal carbon dioxide removal—as Dr. McAuley aims to translate early findings into tangible improvements in patient outcomes.

This episode offers critical insights into the changing landscape of ARDS research and patient care, as Dr. McAuley articulates a hopeful vision for the future—one in which targeted, individualized treatments can improve outcomes for patients with one of critical care’s most challenging conditions.

Dr. McAuley is a consultant and professor in intensive care medicine in the regional intensive care unit at the Royal Victoria Hospital and Queen’s University of Belfast. He is program director for the  Medical Research Council/National Institute for Health and Care Research (MRC/NIHR) Efficacy and Mechanism Evaluation Program and scientific director for programs in NIHR.   Access Dr. McAuley’s Congress Thought Leader Session, ARDS: From Treating a Syndrome to Identifying Modifiable Traits here.

Dr. Barr shares her personal journey from traditional ICU practices of heavy sedation and immobility to leading efforts that prioritize patient recovery, well-being, and post-ICU quality of life. She emphasizes how ICU Liberation reintroduced low-tech, high-impact interventions such as minimizing sedation, promoting early mobility, and engaging families—leading to better outcomes at lower costs. She cites the 2017 international survey by Morandi et al that demonstrated uneven but steady improvements in global ICU Liberation practices before the pandemic (Morandi A, et al. Crit Care Med. 2017;45:e1111-e1122).

Dr. Barr details the need for reeducation, multidisciplinary team engagement, and reworking electronic health record (EHR) systems to better support ICU Liberation goals.

Looking forward, Dr. Barr offers a "burning platform" approach, stressing that delaying ICU Liberation practices risks poorer patient outcomes. She advocates for cultural change, leadership engagement, real-time metrics visibility, and hospital-wide investment—including IT support to surface buried ICU Liberation Bundle data within EHRs.

By reframing ICU Liberation as a "team sport" and making best practices part of daily ICU culture, Dr. Barr believes institutions can reestablish the bundle’s momentum and reconnect healthcare teams to their core mission—helping patients return to meaningful lives after critical illness.

This conversation offers energizing, practical strategies for ICU teams at every stage of ICU Liberation implementation or reinvigoration.

Dr. Duncan, director of wellness for graduate medical education (GME), and Dr. Cabral, a staff psychologist for GME, both at Washington University School of Medicine, share insights from their work supporting trainees’ personal and professional growth. Together, they explore the nuanced meaning of well-being—not as constant happiness, but as a sense of satisfaction and alignment with a person’s values, even amid challenges.

The conversation highlights the importance of helping team members identify and live by their personal values as a foundation for career satisfaction. Dr. Cabral distinguishes between goals and values, underscoring that, while goals can be achieved or not, values guide how a person shows up in all aspects of life. She outlines how residents and other early-career professionals can uncover values by reflecting on meaningful or difficult work experiences. These reflections can then guide decisions about clinical rotations, job searches, and leadership opportunities.

Dr. Duncan emphasizes how small but intentional adjustments—such as carving out just 20% of one’s time for personally meaningful work—can protect against burnout. Both guests discuss the critical role leaders play in supporting well-being, from understanding each team members’ values to fostering a strong sense of community.

They refer to The Burnout Challenge (Maslach C, Leiter MP. Harvard University Press. 2024), which outlines six workplace drivers of burnout, including mismatches in values.

Finally, the episode highlights the work of the Mayo Clinic’s Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) Groups. The COMPASS randomized clinical trial (West CP, et al. Mayo Clin Proc. 2021;96:2606-2614) evaluated a small group established to promote well-being. The group was provided discussion topics without trained facilitators. Protected time was not provided but meal expenses were compensated. This model showed positive outcomes in reducing burnout and strengthening collegial connections.

This episode is part of SCCM’s Leadership, Empowerment, and Development (LEAD) series and offers actionable insights for anyone invested in building healthier, value-aligned medical careers.

Dr. Wai is a critical care specialist and director of critical care medicine fellowship at Children’s National Hospital in Washington, DC. Dr. Basu is a critical care specialist, associate chief of critical care medicine, and associate director of critical care fellowship at Children’s National Hospital in Washington, DC.

Find more expert-developed articles from Pediatric Critical Care Medicine at pccmjournal.org.

Dr. Targa is a researcher at the Center for Biomedical Research Network - CIBER in Madrid, Spain.

Find more expert-developed articles from Critical Care Medicine at ccmjournal.org.

This podcast aims to raise awareness for nurses and other critical care practitioners wanting to enter the research and publishing fields. This unique professional development topic is designed for healthcare workers at the beginning of their research and publishing journeys. Dr. Meissen stresses that publishing is vital for advancing nursing practice and improving patient care, urging clinicians to “just get started” on their research and writing journeys.

She emphasizes the importance of finding a mentor to help refine research questions, structure projects, and navigate challenges. She provides practical advice on identifying a research topic, conducting a literature review, and selecting the appropriate journal for submission. The discussion also highlights imposter syndrome among new writers and how overcoming self-doubt is crucial to getting published.

The conversation touches on the peer review process, including how to handle feedback constructively and spot predatory journals that seek publication fees without legitimate editorial oversight. Dr. Meissen also discusses the role of AI in writing and research, cautioning against its misuse while acknowledging its potential benefits.

Finally, she encourages nurses to participate in the Society of Critical Care Medicine (SCCM) Reviewer Academy, which aims to train a community of trusted, skilled, and diverse peer reviewers to perform high-quality reviews for the SCCM journals (Alexander P, et al. Crit Care Med. 2023;51:1111-1123). Learn more about the SCCM Reviewer Academy at sccm.org/journals.

Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is a neurocritical care nurse practitioner at University of Florida Health Jacksonville. She is active within SCCM, serving on both the APP Resource and Ultrasound committees, and is a social media ambassador for SCCM.

Heather Meissen, DNP, FCCM, is a nurse practitioner and associate clinical professor at Emory Healthcare in Atlanta, Georgia.

Ron Wald, MDCM, MHP, professor of medicine at the University of Toronto, discusses his article, “Initiation of Continuous Renal Replacement Therapy Versus Intermittent Hemodialysis in Critically Ill Patients With Severe Acute Kidney Injury: A Secondary Analysis of STARRT-AKI Trial,” published in the November 2023 issue of Intensive Care Medicine.

Jay Koyner, MD, professor of medicine and director of the nephrology intensive care unit at the University of Chicago, discuss his article, “Initial Renal Replacement Therapy (RRT) Modality Associates With 90-Day Postdischarge RRT Dependence in Critically Ill AKI Survivors,” published in the August 2024 issue of Journal of Critical Care.

This podcast is sponsored by Vantive U.S. Healthcare. Vantive supports true patient-focused treatments with industry-leading CRRT technology and is a partner dedicated to optimizing your clinical success in treating patients with acute kidney injury. Our commitment to you starts with education and provides complete support every step of the way. Visit us at vantive.com.

In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death.

The Society of Critical Care Medicine (SCCM) offers several additional resources to support critical care clinicians’ understanding of the updated guidelines, including an article published in the March 2024 issue of Critical Care Medicine addressing what the critical care team needs to know about the guidelines (Kirschen MP, et al. Crit Care Med. 2024;52:376-386). Dr. Kirchen was the lead author of that article and shares key points in this podcast episode.

Other resources include:

• Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guidelines 2024 Critical Care Congress presentation
• Free AAN evaluation tool that walks clinicians through the process of brain death evaluation.
• Special article in Neurology: Clinical Practice that provides a detailed narrative about what has changed in the 2023 guidelines compared to prior guidelines. The article also includes tables outlining comparisons, bolding new recommendations, and italicizing age-specific guidance to easily identify the differences between determining brain death in children versus adults.